Stent for treating vulnerable plaque

ABSTRACT

An intravascular stent assembly for implantation in a body lumen, such as a coronary artery, is designed to treat a lesion with vulnerable plaque by reducing the fibrous cap stresses. The stent includes distal, proximal, and center sections where the center section is configured to treat the vulnerable plaque. The stent consists of radially expandable cylindrical rings generally aligned on a common longitudinal stent axis and either directly connected or interconnected by one or more interconnecting links placed so that the stent is flexible in the longitudinal direction while providing high degrees of radial strength and vessel scaffolding.

BACKGROUND OF THE INVENTION

The present invention relates to vascular repair devices, and inparticular to intravascular stents, which are adapted to be implantedinto a patient's body lumen, such as a blood vessel or coronary artery,for the treatment of unstable or vulnerable, human atheroscleroticplaque.

Currently, the treatment of unstable or vulnerable plaque presents asignificant therapeutic challenge to medical investigators. Vulnerableplaque is characterized by a basic lesion which is a raised plaquebeneath the innermost arterial layer, the intima. Atheroscleroticplaques are primarily composed of varying amounts of long chainextracellular matrix (ECM) proteins that are synthesized by smoothmuscle cells. The other primary lesion component of atheroscleroticplaque includes lipoproteins, existing both extracellularly and withinfoam cells derived primarily from lipid-laden macrophages. In a moreadvanced lesion, a necrotic core may develop, consisting of lipids, foamcells, cell debris, and cholesterol crystals, and myxomatousconfigurations with crystalline lipid forms. The necrotic core is richin tissue factor and quite thrombogenic, but in the stable plaque it isprotected from the luminal blood flow by a robust fibrous cap composedprimarily of long chain ECM proteins, such as elastin and collagen,which maintain the strength of the fibrous cap. The aforementionedplaque represents the most common form of vulnerable plaque, known as afibroatheroma. Histology studies from autopsy suggest this formconstitutes the majority of vulnerable plaques in humans. A second formof vulnerable plaque represents a smaller fraction of the total, andthese are known as erosive plaques. Erosive plaques generally have asmaller content of lipid, a larger fibrous tissue content, and varyingconcentrations of proteoglycans. Various morphologic features that havebeen associated with vulnerable plaque, include thinned or erodedfibrous caps or luminal surfaces, lesion eccentricity, proximity ofconstituents having very different structural moduli, and theconsistency and distribution of lipid accumulations. With the rupture offibroatheroma forms of vulnerable plaque, the luminal blood becomesexposed to tissue factor, a highly thrombogenic core material, which canresult in total thrombotic occlusion of the artery. In the erosive formof vulnerable plaque, mechanisms of thrombosis are less understood butmay still yield total thrombotic occlusion.

Although rupture of the fibrous cap in a fibroatheroma is a major causeof myocardial infarction (MI) related deaths, there are currently notherapeutic strategies in place to treat lesions that could lead toacute MI. The ability to detect vulnerable plaques and to treat themsuccessfully with interventional techniques before acute MI occurs haslong been an elusive goal. Numerous finite element analysis (FEA)studies have proved that, in the presence of a soft lipid core, thefibrous cap shows regions of high stresses. Representative of thesestudies include the following research articles, each of which areincorporated in their entirety by reference herein: Richardson et al.(1989), Influence of Plaque Configuration and Stress Distribution onFissuring of Coronary Atherosclerotic Plaques, Lancet, 2 (8669),941-944; Loree et al. (1992), Effects of Fibrous Cap Thickness onCircumferential Stress in Model Atherosclerotic Vessels, CirculationResearch, 71, 850-858; Cheng et al. (1992), Distribution ofCircumferential Stress in Ruptured and Stable Atherosclerotic Lesions: AStructural Analysis With Histopathological Correlation, Circulation, 87,1179-1187; Veress et al. (1993), Finite Element Modeling ofAtherosclerotic Plaque, Proceedings of IEEE Computers in Cardiology,791-794; Lee et al. (1996), Circumferential Stress and MatrixMetalloproteinase 1 in Human Coronary Atherosclerosis: Implications forPlaque Rupture, Atherosclerosis Thrombosis Vascular Biology, 16,1070-1073; Vonesh et al. (1997), Regional Vascular Mechanical Propertiesby 3-D Intravascular Ultrasound Finite-Element Analysis, AmericanJournal of Physiology, 272, 425-437; Beattie et al. (1999), MechanicalModeling: Assessing Atherosclerotic Plaque Behavior and Stability inHumans, International Journal of Cardiovascular Medical Science, 2 (2),69-81; and Feezor et al. (2001), Integration of Animal and HumanCoronary Tissue Testing with Finite Element Techniques for AssessingDifferences in Arterial Behavior, BED-Vol. 50, 2001 BioengineeringConference, ASME 2001. Further, these studies have indicated that suchhigh stress regions correlate with the observed prevalence of locationsof cap fracture. Moreover, it has been shown that subintimal structuralfeatures such as the thickness of the fibrous cap and the extent of thelipid core, rather than stenosis severity are critical in determiningthe vulnerability of the plaque. The rupture of a highly stressedfibrous cap can be prevented by using novel, interventional, therapeutictechniques such as specially designed stents that redistribute and lowerthe stresses in the fibrous cap.

One of the avenues to reduce cap rupture is to reinforce the strengthand increase thickness of the fibrous cap. Studies have shown thatplacement of the intravascular stent at a lesion site can induceneointimal thickening. Using the same reasoning, placing anintravascular stent at the vulnerable plaque site can induce neointimalthickening, which in turn will increase the cap thickness. However, aspecial stent pattern, rather than the traditional workhorse stent,should be used to stent these lesions. A pattern which induces lessshear stress upon expansion, less point stress upon the vessel wall anddelayed neointimal thickening should be used for stent vulnerableplaques.

Stents are generally tubular-shaped devices which function to hold opena segment of a blood vessel, coronary artery, or other body lumen. Theyare particularly suitable for use to support and hold back a dissectedarterial lining which can occlude the fluid passageway therethrough.

Various means have been described to deliver and implant stents. Onemethod frequently described for delivering a stent to a desiredintraluminal location includes mounting the expandable stent on anexpandable member, such as a balloon, provided on the distal end of anintravascular catheter, advancing the catheter to the desired locationwithin the patient's body lumen, inflating the balloon on the catheterto expand the stent into a permanent expanded condition and thendeflating the balloon and removing the catheter. One of the difficultiesencountered using prior art stents involved maintaining the radialrigidity needed to hold open a body lumen while at the same timemaintaining the longitudinal flexibility of the stent to facilitate itsdelivery. Once the stent is mounted on the balloon portion of thecatheter, it is often delivered through tortuous vessels, includingtortuous coronary arteries. The stent must have numerous properties andcharacteristics, including a high degree of flexibility, in order toappropriately navigate the tortuous coronary arteries. This flexibilitymust be balanced against other features including radial strength oncethe stent has been expanded and implanted in the artery. While othernumerous prior art stents have had sufficient radial strength to holdopen and maintain the patency of a coronary artery, they have lacked theflexibility required to easily navigate tortuous vessels withoutdamaging the vessels during delivery.

Generally speaking, most prior art intravascular stents are formed froma metal such as stainless steel, which is balloon expandable andplastically deforms upon expansion to hold open a vessel. The componentparts of these types of stents typically are all formed of the same typeof metal, i.e., stainless steel. Other types of prior art stents may beformed from a polymer, again all of the component parts being formedfrom the same polymer material. These types of stents, the ones formedfrom a metal and the ones formed from a polymer, each have advantagesand disadvantages. One of the advantages of the metallic stents is theirhigh radial strength once expanded and implanted in the vessel. Adisadvantage may be that the metallic stent lacks flexibility which isimportant during the delivery of the stent to the target site. Withrespect to polymer stents, they may have a tendency to be quite flexibleand are advantageous for use during delivery through tortuous vessels,however, such polymer stents may lack the radial strength necessary toadequately support the lumen once implanted into an occlusivefibromuscular lesion of 70% stenosis or greater.

What has been needed and heretofore unavailable is a stent that can beused to treat a vulnerable plaque by reducing the cap stresses. Thepresent invention satisfies this need and others.

SUMMARY OF THE INVENTION

The present invention is directed to an intravascular stent assemblythat can be used to treat a lesion with vulnerable plaque by reducingthe cap stresses. The invention also includes methods of using the stentassembly for the treatment of the same.

The stent assembly embodying features of the invention can be readilydelivered to the desired body lumen, such as a coronary artery(peripheral vessels, bile ducts, etc.), by mounting the stent assemblyon an expandable member of a delivery catheter, for example a balloon,and advancing the catheter and stent assembly through the body lumen tothe target site. Generally, the stent is compressed or crimped onto theballoon portion of the catheter so that the stent assembly does not movelongitudinally relative to the balloon portion of the catheter duringdelivery through the arteries, and during expansion of the stent at thetarget site. The stent is relatively flexible along its longitudinalaxis to facilitate delivery through tortuous body lumens yet is stiffand stable enough radially in an expanded condition to maintain thepatency of a body lumen such as an artery when implanted therein.

In one embodiment, the stent assembly of the invention includes a seriesof cylindrical rings formed with undulations and located within distal,center, and proximal sections of the stent. The undulations of the ringslocated in the center section may have either smaller or largercross-sectional widths than the undulations of the rings in the distaland proximal sections in order to accommodate the vulnerable plaquesection of the artery. Links are incorporated to connect all thecylindrical rings together into the stent assembly. The center sectionmay be coated with a polymer to increase surface area.

In another embodiment, the stent assembly of the present inventionincludes a series of cylindrical rings with undulations and also locatedwithin distal, center, and proximal sections of the stent. Similarly,the undulations of the rings located in the center section may haveeither smaller or larger cross-sections than the undulations of therings in the distal and proximal sections in order to accommodate thevulnerable plaque section of the artery. The rings are directlyconnected to each other, generally without the need for separate links.The center section may also be coated with a polymer to increase surfacearea.

The resulting stent structures are a series of radially expandablecylindrical rings which are configured so that vulnerable plaque andsmall dissections in the wall of a body lumen may be pressed back intoposition against the luminal wall, while maintaining the longitudinalflexibility of the stent both when being negotiated through the bodylumens in their unexpanded state and when expanded into position. Therings within the center section are arranged to provide the section witha high surface area density to reduce the likelihood of plaque ruptureby creating less stress on the plaque. The high surface area also helpsto reduce the scissoring affect the center section rings may have uponexpansion. Undulations within the cylindrical rings allow for an evenexpansion around the circumference by accounting for the relativedifferences in stress created by the radial expansion of the cylindricalrings. Each of the individual cylindrical rings may rotate slightlyrelative to their adjacent cylindrical rings without significantdeformation, cumulatively providing stents which are flexible alongtheir length and about their longitudinal axis, but which are still verystable in the radial direction in order to resist collapse afterexpansion.

Each of the embodiments of the invention can be readily delivered to thedesired luminal location by mounting them on an expandable member of adelivery catheter, for example a balloon, and passing the catheter-stentassembly through the body lumen to the implantation site. A variety ofmeans for securing the stents to the expandable member on the catheterfor delivery to the desired location is available. It is presentlypreferred to compress the stent onto the unexpanded balloon. Other meansto secure the stent to the balloon include providing ridges or collarson the inflatable member to restrain lateral movement, usingbioabsorbable temporary adhesives, or a retractable sheath to cover thestent during delivery through a body lumen.

The presently preferred structures for the expandable cylindrical ringswhich form the stents of the present invention generally have aplurality of circumferential undulations containing a plurality ofalternating peaks and valleys. The peaks and valleys are formed ingenerally U- and V-shaped patterns and aligned along the longitudinalaxis.

While the cylindrical rings and links generally are not separatestructures, they have been conveniently referred to as rings and linksfor ease of identification. Further, the cylindrical rings can bethought of as comprising a series of U- and V-shaped structures in arepeating pattern. While the cylindrical rings are not divided up orsegmented into U's and V's, the pattern of cylindrical rings resemblesuch configuration. The U's and V's promote flexibility in the stentprimarily by flexing and may tip radially outwardly as the stent isdelivered through a tortuous vessel.

The undulations of the cylindrical rings can have different degrees ofcurvature and angles of adjacent peaks and valleys to compensate for theexpansive properties of the peaks and valleys. The cylindrical rings ofthe stents are plastically deformed when expanded (except with NiTialloys) so that the stents will remain in the expanded condition andtherefore they must be sufficiently rigid when expanded to prevent thecollapse thereof in use.

With stents formed from super-elastic nickel-titanium (NiTi) alloys, theexpansion occurs when the stress of compression is removed. This allowsthe phase transformation from martensite back to austenite to occur, andas a result the stent expands.

After the stents are expanded some of the peaks and/or valleys may, butnot necessarily, tip outwardly and embed in the vessel wall. Thus, afterexpansion, the stents may not have a smooth outer wall surface, ratherthey have small projections which embed in the vessel wall and aid inretaining the stents in place in the vessel.

The links which interconnect adjacent cylindrical rings can have across-section similar to the cross-sections of the undulating componentsof the expandable cylindrical rings. The links may be formed in aunitary structure with the expandable cylindrical rings formed from thesame intermediate product, such as a tubular element, or they may beformed independently and mechanically secured between the expandablecylindrical rings. The links may be formed substantially straight orwith a plurality of undulations. They may also be used primarily tosupport the vulnerable plaque region or primarily to connect adjacentrings.

Preferably, the number, shape and location of the links can be varied inorder to develop the desired vulnerable plaque coverage and longitudinalflexibility. These properties are important to minimize alteration ofthe natural physiology of the body lumen into which the stent isimplanted and to maintain the compliance of the body lumen which isinternally supported by the stent. Generally, the greater thelongitudinal flexibility of the stents, the easier and the more safelythey can be delivered to the implantation site, especially where theimplantation site is on a curved section of a body lumen, such as acoronary artery or a peripheral blood vessel, and especially saphenousveins and larger vessels.

The stent may be formed from a tube by laser cutting the pattern ofcylindrical rings and undulating links in the tube, by individuallyforming wire rings and laser welding them together, and by laser cuttinga flat metal sheet in the pattern of the cylindrical rings and links,and then rolling the pattern into the shape of the tubular stent andproviding a longitudinal weld to form the stent.

Other features and advantages of the present invention will become moreapparent from the following detailed description of the invention, whentaken in conjunction with the accompanying exemplary drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is an elevational view, partially in section, of a stentembodying features of the invention which is mounted on a deliverycatheter and disposed within a damaged artery.

FIG. 2 is an elevational view, partially in section, similar to thatshown in FIG. 1 wherein the stent is expanded within a damaged ordiseased artery.

FIG. 3 is an elevational view, partially in section, depicting theexpanded stent within the artery after withdrawal of the deliverycatheter.

FIG. 4 is a perspective view of the center section of the stent of FIG.3 in its expanded state depicting the serpentine pattern along the peaksand valleys that form the cylindrical rings.

FIG. 5 is a schematic of a process of fibrous cap rupture in afibroatheroma form of vulnerable plaque leading to a thromboticocclusion of an artery.

FIG. 6 is a plan view of a flattened section of one embodiment of astent of the invention including undulating links and U- and V-shapedring undulations.

FIG. 6 a is a cross-sectional view of an undulation within a center ringtaken along line 6 a-6 a of FIG. 6.

FIG. 6 b is a cross-sectional view of an undulation within a distal ringtaken along line 6 b-6 b of FIG. 6.

FIG. 7 is a plan view of a flattened section of one embodiment of astent of the invention including two sets of rings, each with U-shapedundulations.

FIG. 7 a is a cross-sectional view of an undulation within a center ringtaken along line 7 a-7 a of FIG. 7.

FIG. 7 b is a cross-sectional view of an undulation within a distal ringtaken along line 7 b-7 b of FIG. 7.

FIG. 8 is a plan view of a flattened section of one embodiment of astent of the invention including two sets of rings with U-shapedundulations where the rings are directly connected to each other.

FIG. 8 a is a cross-sectional view of an undulation within a center ringtaken along line 8 a-8 a of FIG. 8.

FIG. 8 b is a cross-sectional view of an undulation within a distal ringtaken along line 8 b-8 b of FIG. 8.

FIG. 9 is a plan view of a flattened section of one embodiment of astent of the invention including two sets of rings with U-shapedundulations where a center set consists of two rings.

FIG. 9 a is a cross-sectional view of an undulation within a center ringtaken along line 9 a-9 a of FIG. 9.

FIG. 9 b is a cross-sectional view of an undulation within a distal ringtaken along line 9 b-9 b of FIG. 9.

FIG. 10 is a plan view of a flattened section of one embodiment of astent of the invention including a center set consisting of four rings.

FIG. 10 a is a cross-sectional view of an undulation within a centerring taken along line 10 a-10 a of FIG. 10.

FIG. 10 b is a cross-sectional view of an undulation within a distalring taken along line 10 b-10 b of FIG. 10.

FIG. 11 is a plan view of a flattened section of one embodiment of astent of the invention including six links within a center section.

FIG. 11 a is a cross-sectional view of an undulation within a centerlink taken along line 11 a-11 a of FIG. 11.

FIG. 11 b is a cross-sectional view of an undulation within a distalring taken along line 11 b-11 b of FIG. 11.

FIG. 12 is a plan view of a flattened section of one embodiment of astent of the invention including twelve links within a center section.

FIG. 12 a is a cross-sectional view of an undulation within a centerlink taken along line 12 a-12 a of FIG. 12.

FIG. 12 b is a cross-sectional view of an undulation within a distalring taken along line 12 b-12 b of FIG. 12.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Before describing in detail an exemplary embodiment of a stent for thetreatment of a vulnerable plaque in accordance with the presentinvention, it is instructive to briefly describe a typical stentimplantation procedure and the vascular conditions which are typicallytreated with stents.

Turning to the drawings, FIG. 1 depicts a metallic stent 10incorporating features of the invention mounted on a catheter assembly12 which is used to deliver the stent and implant it in a body lumen,such as a coronary artery, peripheral artery, or other vessel or lumenwithin the body. The stent generally includes a plurality of radiallyexpandable cylindrical rings 11,13 disposed generally coaxially andinterconnected by undulating links 15 and straight links 17 disposedbetween adjacent cylindrical rings. The stent as shown in FIG. 2generally includes distal 21, center 23, and proximal 25 sections. Thecatheter assembly shown in FIG. 1 includes a catheter shaft 13 which hasa proximal end 14 and a distal end 16. The catheter assembly isconfigured to advance through the patient's vascular system by advancingover a guide wire by any of the well known methods of an over the wire(OTW) system (not shown) or a well known rapid exchange (RX) cathetersystem, such as the one shown in FIG. 1.

Catheter assembly 12 as depicted in FIG. 1 is of the well known rapidexchange type which includes an RX port 20 where the guide wire 18 willexit the catheter. The distal end of the guide wire exits the catheterdistal end 16 so that the catheter advances along the guide wire on asection of the catheter between the RX port and the catheter distal end.As is known in the art, the guide wire lumen which receives the guidewire is sized for receiving various diameter guide wires to suit aparticular application. The stent is mounted on the expandable member 22(balloon) and is crimped tightly thereon so that the stent andexpandable member present a low profile diameter for delivery throughthe arteries.

As shown in FIG. 1, a partial cross-section of an artery 24 is shownwith a small amount of plaque 25 that has been previously treated by anangioplasty or other repair procedure. Stent assembly 10 of the presentinvention is used to repair a diseased or damaged arterial wall whichmay include the plaque as shown in FIG. 1, or a dissection, or a flapwhich are commonly found in the coronary arteries, peripheral arteriesand other vessels.

In a typical procedure to implant stent assembly 10, the guide wire 18is advanced through the patient's vascular system by well known methodsso that the distal end of the guide wire is advanced past the plaque ordiseased area 26. Prior to implanting the stent assembly, thecardiologist may wish to perform an angioplasty procedure or otherprocedure (i.e., atherectomy) in order to open the vessel and remodelthe diseased area. Thereafter, the stent delivery catheter assembly 12is advanced over the guide wire so that the stent assembly is positionedin the target area. The expandable member or balloon 22 is inflated bywell known means so that it expands radially outwardly and in turnexpands the stent assembly radially outwardly until the stent assemblyis apposed to the vessel wall. The expandable member is then deflatedand the catheter withdrawn from the patient's vascular system. The guidewire typically is left in the lumen for post-dilatation procedures, ifany, and subsequently is withdrawn from the patient's vascular system.As depicted in FIG. 2, the balloon is fully inflated with the stentexpanded and pressed against the vessel wall, and in FIG. 3, theimplanted stent remains in the vessel after the balloon has beendeflated and the catheter assembly and guide wire have been withdrawnfrom the patient.

The stent 10 serves to hold open the artery 24 after the catheter iswithdrawn, as illustrated by FIG. 3. Due to the formation of the stentfrom an elongated tubular member, the undulating components of the stentare relatively flat in transverse cross-section, so that when the stentis expanded, it is pressed into the wall of the artery and as a resultdoes not interfere with the blood flow through the artery. The stent ispressed into the wall of the artery and will eventually be covered withendothelial cell growth which further minimizes blood flow interference.The rings 11,13 and links 15,17 of the stent will eventually becomeendothelialized. It is this endothelialization and subsequent neointimalgrowth that will integrate the device into the fibrous cap portion ofthe vulnerable plaque along with the remainder of the stented portion ofthe artery. This integration will yield lower fibrous cap stressesoverall. The undulating portion of the stent provides good tackingcharacteristics to prevent stent movement within the artery.Furthermore, the closely spaced cylindrical rings at regular intervalsprovide uniform support for the wall of the artery, and consequently arewell adapted to tack up and hold in place small flaps or dissections inthe wall of the artery.

The stent patterns shown in FIGS. 1-3 are for illustration purposes onlyand can vary in size and shape to accommodate different vessels or bodylumens. Further, the stent 10 is of a type that can be used inaccordance with the present invention.

The first set of links and second set of links 15,17 which interconnectadjacent first sets of cylindrical rings and adjacent second sets ofcylindrical rings 11,13 may have cross-sections similar to thecross-sections of the undulating components of either set of expandablecylindrical rings. In one embodiment, all of the links are joined ateither the peaks or the valleys of the undulating structure of adjacentcylindrical rings. In this manner there is little or no shortening ofthe stent assembly upon expansion.

The number and location of the first set of links and the second set oflinks 15,17 connecting the first set of rings and second set of rings11,13 can be varied in order to vary the desired longitudinal andflexural flexibility in the stent assembly structure both in theunexpanded as well as the expanded condition. These properties areimportant to minimize alteration of the natural physiology of the bodylumen into which the stent assembly is implanted and to maintain thecompliance of the body lumen which is internally supported by the stentassembly. Generally, the greater the longitudinal and flexuralflexibility of the stent assembly, the easier and the more safely it canbe delivered to the target site.

With reference to FIG. 4, which illustrates the center section 23 of thestent 10, the cylindrical rings 13 are in the form of undulatingportions. The undulating portion is made up of a plurality of V-shapedmembers 31 having radii that more evenly distribute expansion forcesover the various members. After the cylindrical rings have been radiallyexpanded, outwardly projecting edges 34,36 may be formed. That is,during radial expansion some of the V-shaped members may tip radiallyoutwardly thereby forming outwardly projecting edges. These outwardlyprojecting edges can provide for a roughened outer wall surface of thestent and assist in implanting the stent in the vascular wall byembedding into the vascular wall. In other words, the outwardlyprojecting edges may embed into the vascular wall, for example arterialvessel 24, as depicted in FIG. 3. Depending upon the dimensions of thestent and the thickness of the various members making up the serpentinepattern, any of the U-shaped members can tip radially outwardly to formthe projecting edges. The rings within the distal section and proximalsection 21,25 of the stent can be configured similarly to tip outwardly.

Cylindrical rings 13 can be nested such that adjacent rings slightlyoverlap in the longitudinal direction so that one ring is slightlynested within the next ring and so on. The degree of nesting can bedictated primarily by the length of each cylindrical ring, the number ofundulations in the rings, the thickness of the rings, and the radius ofcurvature, all in conjunction with the crimped or delivery diameter ofthe stent. If the rings are substantially nested one within the other,it may be difficult to crimp the stent to an appropriate deliverydiameter without the various struts overlapping. It is also contemplatedthat the rings may be slightly nested even after the stent is expanded,which enhances vessel wall coverage. In some circumstances, it may notbe desirable to nest one ring within the other, which is alsocontemplated by the invention. As mentioned above, the distal sectionand proximal section 21,25 can be configured similarly.

FIG. 5 illustrates a schematic of a process of fibrous cap rupture in afibroatheroma form of vulnerable plaque leading to a thromboticocclusion of an artery 24 (FIG. 1). A patent lumen 42 at the lesion siteis separated from a lipid core 44 of the lesion by the fibrous cap 40.When the fibrous cap is ruptured 46, the lumenal blood becomes exposedto tissue factor, a highly thrombogenic core material, which can resultin total thrombotic occlusion 48 of the artery. The intravascular stentassembly of the present invention is a novel, interventional,therapeutic technique that redistributes and lowers the stresses in thefibrous cap.

In one embodiment shown in FIG. 6, the stent assembly 10 of the presentinvention has a plurality of a first set and second set 11,13 offlexible undulating cylindrical rings being expandable in a radialdirection, with each of the rings having a first delivery diameter and asecond implanted diameter and being aligned on a common longitudinalaxis. The first set of rings have a cross-section shown in FIG. 6 b witha width 128 and height 130. The first set of links have a similarcross-section. At least one first set link 15 is attached betweenadjacent first set rings to form the distal section and proximal section21,25 of the stent. The first set of links are formed with W-shapedundulations which add to the stent's flexibility. Preferably, each ofthe rings is formed of a metallic material. However, the stent assemblyof the present invention is not limited to the use of such metallicmaterials as non-metallic materials are also contemplated for use withthe invention. The center section 23 has a plurality of a second set ofrings with V-shaped undulations 13 and a second set of substantiallystraight links 17. The second set of rings have a cross-section shown inFIG. 6 a with a width 124 and height 126. The second set of links have asimilar cross-section. The length of a characteristic vulnerable plaqueregion is generally in the range of about 3 to 30 mm, and it ispreferable that the length of the center section is slightly longer thanthe vulnerable plaque region. In any event, the center section should belong enough to cover the vulnerable plaque region. Thus, for someapplications, the center section may be longer or shorter than thedisclosed range. The center section can be fabricated in a multiplicityof sizes in order to accommodate multiple lengths of lesions containingvulnerable plaque that require treatment. The width 124 of the rings andlinks within the center section is smaller than the width 128 of therings and links within the distal and proximal sections and can varydepending on the severity of vulnerable plaque to be treated.

The stent assembly of the present invention is placed in anartherosclerotic artery such that upon deployment the center section 23apposes the region containing the vulnerable plaque. With furtherreference to FIG. 6, the center section 23 of the stent assembly apposesthe treatment site (not shown) within the body lumen while the rings arein the implanted diameter (FIG. 3). This configuration could beapplicable for at least two reasons. First, given that previous studieshave suggested that many vulnerable plaques are not occlusive prior tothe thrombotic event, these plaques could require less scaffoldingstrength than typical metallic stents are designed to provide. Second,in the event of cap rupture within the plaque, the dense center sectioncould provide high coverage and focal drug delivery to the ruptureregion. For purposes of this invention, the treatment site is preferablyan artery 24 having at least one lesion containing vulnerable plaque 25(FIG. 1).

The stent 50 shown in FIG. 7 includes a distal section 51, centersection 53, and proximal section 55. A first set of undulating rings 56with a first cross-section shown in FIG. 7 b with a width 136 and height138 and a first set of substantially straight links 57 also with asimilar cross-section are located within the distal and proximalsections. The links connect adjacent rings in both sections.

The center section 53 includes a second set of undulating rings 58 witha second, relatively smaller cross-section shown in FIG. 7 a with awidth 132 and height 134 and a second set of substantially straightlinks 59 with a similar cross-section connecting adjacent rings. Theundulations 52 of the three center section rings are substantiallyU-shaped and have a smaller width 132 than the width 136 of the U-shapedundulations 54 in the first set of rings. In addition, the second set oflinks are shorter than the first set of distal and proximal links 57 andalso have a smaller width 132. The smaller dimensions and higherundulation concentrations of the second set of rings and links helps toredistribute and lower stresses in the fibrous cap of the artery.

The stent 70 shown in FIG. 8 also includes a distal section 71, centersection 73, and proximal section 75. A first set of undulating rings 76with a first cross-section shown in FIG. 8 b with a width 144 and height146 and located within the distal and proximal sections are directly,adjacently connected through attachment points 77.

The center section 73 includes a second set of undulating rings 78 witha second, smaller cross-section shown in FIG. 8 a with a width 140 andheight 142. Like the first set of rings 76, the second set of threerings are directly, adjacently connected through attachment points 79.Similar to FIG. 7, the undulations 72 of the center section aresubstantially U-shaped and the rings incorporate more undulations perring and have a smaller width 140 than the width 144 of the rings withinthe distal and proximal sections, also with U-shaped undulations 74. Asin FIG. 7, the smaller dimensions of the second set of rings helps toredistribute and lower stresses in the fibrous cap.

The stent 80 shown in FIG. 9 also includes distal section 81, centersection 83, and proximal section 85. A first set of undulating rings 86with a first cross-section shown in FIG. 9 b with a width 152 and height154 and located within the distal and proximal sections are directly,adjacently connected through attachment points 87.

The center section 83 includes a second set of undulating rings 88 witha second, smaller cross-section shown in FIG. 9 a with a width 148 andheight 150. Like the first set of rings 86, the second set of two ringsare directly adjacently connected through attachment points 89. Similarto FIGS. 7 and 8, the undulations 82 of the center section aresubstantially U-shaped and the rings have more undulations per ring thanthe first set of rings 86 located within the distal section 81 andproximal 85 section. The second set of rings are also longer from peak121 to valley 122 than the first set of rings. The increase in lengthhelps flexibility within the center section. As in FIGS. 7 and 8, therelatively smaller width 148 and larger number of U-shaped undulationswithin the center section help to redistribute and lower stresses in thefibrous cap.

The stent 90 shown in FIG. 10 includes a distal section 91, centersection 93, and proximal section 95. A first set of undulating rings 96located within the distal and proximal sections and with a firstcross-section shown in FIG. 10 b with a width 160 and height 162 aredirectly, adjacently connected through attachment points 97.

The center section 93 includes a second set of undulating rings 98 witha second, wider cross-section shown in FIG. 10 a with a width 156 andheight 158. Like the first set of rings 96, the second set of four ringsare directly adjacently connected through attachment points 99. Theundulations 92 of the center section are substantially U-shaped and therings incorporate more undulations per ring and are shorter from peak180 to valley 182 than the distal and proximal rings 96, which alsoincorporate U-shaped undulations 94. When compared to the stent shown inFIG. 8, the stent of FIG. 10, allows a greater fibrous cap coverage areadue to the higher number of second set rings and due to the larger ringcross-sectional width 156.

The stent 100 shown in FIG. 11 also includes a distal section 101,center section 103, and proximal section 105. A first set of undulatingrings 106 located within the proximal section and a second set ofundulating rings 104 located within the distal section, each with afirst cross-section shown in FIG. 11 b with a width 168 and height 170and second cross-section, respectively, are each directly, adjacentlyconnected through attachment points 107. In this particular embodiment,the first and second set of rings are identically configured and sharethe same cross-section shown in FIG. 11 b.

The center section 103 differs from previous embodiments because itincorporates a series of six links 109 to cover the fibrous cap of anartery. The links incorporate U-shaped undulations 102 which arearranged perpendicular to the stent longitudinal axis and connect to theU-shaped undulations 102 b within the rings 104,106. The undulationsallow the links to cover more surface area and have greater flexibilitythan would a similar straight link. The links also incorporate across-section shown in FIG. 11 a with a relatively smaller width 164 andheight 166 for added flexibility.

The stent 110 shown in FIG. 12 also includes a distal section 111,center section 113, and proximal section 115. Similar to FIG. 11, aseries of links 119 form the center section of the stent of the presentembodiment.

A first set of undulating rings 116 located within the proximal sectionand a second set of undulating rings 114 are located with the distalsection, each with a first cross-section shown in FIG. 12 b with a width176 and height 178 and second cross-section, respectively, are eachdirectly, adjacently connected through a first set of links 117. In thisparticular embodiment, the first and second set of rings are identicallyconfigured and share the same cross-section shown in FIG. 12 b. Thefirst set of links are configured with a cross-section identical to therings.

The center section 113 incorporates a second set of twelve links 119 tocover the fibrous cap of an artery. The second set of links, like thelinks 109 shown in FIG. 11, incorporate U-shaped undulations 112 whichare arranged perpendicular to the stent longitudinal axis. The secondset of links also incorporate straight portions 118 that fit within theU-shaped undulations 112 b, 112 c of the rings 116,114. The links alsoincorporate a cross-section shown in FIG. 12 a with a relatively smallerwidth 172 and height 179.

The stents of the present invention can be made in many ways. However,the preferred method of making the stent is to cut a thin-walled tubularmember, such as stainless steel tubing to remove portions of the tubingin the desired pattern for the stent, leaving relatively untouched theportions of the metallic tubing which are to form the stent. It ispreferred to cut the tubing in the desired pattern by means of amachine-controlled laser, which is well known in the art.

The stent tubing may be made of suitable biocompatible material such asstainless steel, titanium, tungsten, tantalum, vanadium, cobaltchromium, gold, palladium, platinum, and iradium, super-elastic(nickel-titanium) NiTi alloys and even high strength thermoplasticpolymers. The stent diameters are very small, so the tubing from whichit is made must necessarily also have a small diameter. For PCTAapplications, typically the stent has an outer diameter on the order ofabout 1.65 mm (0.065 inches) in the unexpanded condition, the same outerdiameter of the hypotubing from which it is made, and can be expanded toan outer diameter of 5.08 mm (0.2 inches) or more. The wall thickness ofthe tubing is about 0.076 mm (0.003 inches). For stents implanted inother body lumens, such as PTA applications, the dimensions of thetubing are correspondingly larger. While it is preferred that the stentsbe made from laser cut tubing, those skilled in the art will realizethat the stent can be laser cut from a flat sheet and then rolled up ina cylindrical configuration with the longitudinal edges welded to form acylindrical member.

In the instance when the stents are made from plastic, the implantedstent may have to be heated within the arterial site where the stentsare expanded to facilitate the expansion of the stent. Once expanded, itwould then be cooled to retain its expanded state. The stent may beconveniently heated by heating the fluid within the balloon or theballoon itself directly by a known method.

The stents may also be made of materials such as super-elastic(sometimes called pseudo-elastic) nickel-titanium (NiTi) alloys. In thiscase the stent would be formed full size but deformed (e.g. compressed)to a smaller diameter onto the balloon of the delivery catheter tofacilitate intraluminal delivery to a desired intraluminal site. Thestress induced by the deformation transforms the stent from an austenitephase to a martensite phase, and upon release of the force when thestent reaches the desired intraluminal location, allows the stent toexpand due to the transformation back to the more stable austenitephase. Further details of how NiTi super-elastic alloys operate can befound in U.S. Pat. Nos. 4,665,906 (Jervis) and 5,067,957 (Jervis),incorporated herein by reference in their entirety.

The stent of the invention also can be coated with a drug or therapeuticagent. Further, it is well known that the stent (when made from a metal)may require a primer material coating such as a polymer to provide asubstrate on which a drug or therapeutic agent is coated since somedrugs and therapeutic agents do not readily adhere to a metallicsurface. The drug or therapeutic agent can be combined with a coating orother medium used for controlled release rates of the drug ortherapeutic agent. Examples of therapeutic agents or drugs that aresuitable for use with the polymeric materials include sirolimus,everolimus, actinomycin D (ActD), taxol, paclitaxel, or derivatives andanalogs thereof. Examples of agents include other antiproliferativesubstances as well as antineoplastic, antiinflammatory, antiplatelet,anticoagulant, antifibrin, antithrombin, antimitotic, antibiotic, andantioxidant substances. Examples of antineoplastics include taxol(paclitaxel and docetaxel). Further examples of therapeutic drugs oragents that can be combined with the polymeric materials includeantiplatelets, anticoagulants, antifibrins, antithrombins, andantiproliferatives. Examples of antiplatelets, anticoagulants,antifibrins, and antithrombins include, but are not limited to, sodiumheparin, low molecular weight heparin, hirudin, argatroban, forskolin,vapiprost, prostacyclin and prostacyclin analogs, dextran,D-phe-pro-arg-chloromethylketone (synthetic antithrombin), dipyridamole,glycoprotein IIb/IIIa platelet membrane receptor antagonist, recombinanthirudin, thrombin inhibitor (available from Biogen located in Cambridge,Mass.), and 7E-3B® (an antiplatelet drug from Centocor located inMalvern, Pa.). Examples of antimitotic agents include methotrexate,azathioprine, vincristine, vinblastine, fluorouracil, adriamycin, andmutamycin. Examples of cytostatic or antiproliferative agents includeangiopeptin (a somatostatin analog from Ibsen located in the UnitedKingdom), angiotensin converting enzyme inhibitors such as Captopril®(available from Squibb located in New York, N.Y.), Cilazapril®(available from Hoffman-LaRoche located in Basel, Switzerland), orLisinopril® (available from Merck located in Whitehouse Station, N.J.);calcium channel blockers (such as Nifedipine), colchicine, fibroblastgrowth factor (FGF) antagonists, fish oil (omega 3-fatty acid),histamine antagonists, Lovastatin® (an inhibitor of HMG-CoA reductase, acholesterol lowering drug from Merck), methotrexate, monoclonalantibodies (such as PDGF receptors), nitroprusside, phosphodiesteraseinhibitors, prostaglandin inhibitor (available from GlaxoSmithKlinelocated in United Kingdom), Seramin (a PDGF antagonist), serotoninblockers, steroids, thioprotease inhibitors, triazolopyrimidine (a PDGFantagonist), and nitric oxide. Other therapeutic drugs or agents whichmay be appropriate include alpha-interferon, genetically engineeredepithelial cells, and dexamethasone.

While the foregoing therapeutic agents have been used to prevent ortreat restenosis, they are provided by way of example and are not meantto be limiting, since other therapeutic drugs may be developed which areequally applicable for use with the present invention. The treatment ofdiseases using the above therapeutic agents are known in the art.Furthermore, the calculation of dosages, dosage rates and appropriateduration of treatment are previously known in the art.

While the invention has been illustrated and described herein in termsof its use as intravascular stents, it will be apparent to those skilledin the art that the stents can be used in other instances in all vesselsin the body. Since the stents of the present invention have the novelfeature of enhanced longitudinal flexibility due to their angulatedundulations, they are particularly well suited for implantation inalmost any vessel where such devices are used. This feature, coupledwith limited longitudinal contraction of the stent when radiallyexpanded, provides a highly desirable support member for all vessels inthe body. Other modifications and improvements may be made withoutdeparting from the scope of the invention.

1. An intravascular stent, comprising: a plurality of a first set ofcylindrical rings and a plurality of a second set of cylindrical rings,each set of cylindrical rings being radially expandable, longitudinallyaligned, and each with a first delivery diameter and a second implanteddiameter; a plurality of links connecting a plurality of adjacentcylindrical rings; wherein the stent includes a distal section, a centersection, and a proximal section; wherein the first set of rings areformed with a first cross-sectional width and the second set of ringsare formed with a second, relatively smaller cross-sectional width. 2.The stent of claim 1, wherein the first set of rings are located withinthe proximal section and the distal section of the stent and the secondset of rings are located within the center section of the stent.
 3. Thestent of claim 1, wherein the links comprise a first set with a firstcross-sectional width and a second set with a second, relatively smallercross-sectional width than the width of the first set of links. 4.(canceled)
 5. The stent of claim 1, wherein a plurality of the links areformed with W-shaped undulations.
 6. The stent of claim 1, wherein thefirst set of rings are formed with V-shaped and U-shaped undulations andwherein the second set of rings are formed with V-shaped undulations. 7.The stent of claim 1, wherein the second set of rings is formed withU-shaped undulations.
 8. The stent of claim 1, wherein the first set ofrings and the second set of rings are formed with substantially U-shapedundulations.
 9. The stent of claim 1, wherein adjacent rings areconnected with three links.
 10. The stent of claim 1, wherein the firstset of rings and the second set of rings are located with the proximalsection and the distal section of the stent and the links are locatedwithin the center section of the stent.
 11. The stent of claim 10,wherein there are six links connecting two rings.
 12. The stent of claim10, wherein twelve links connect two rings.
 13. The stent of claim 10,wherein a plurality of the first set of rings and a plurality of thesecond sets of rings are directly connected. 14-22. (canceled)
 23. Thestent of claim 1, wherein the stent is self-expanding.
 24. The stent ofclaim 23, wherein the material forming the cylindrical rings embodiesshape memory characteristics.
 25. The stent of claim 24, wherein theshape memory material is a superelastic material.
 26. The stent of claim25, wherein the superelastic material is nickel-titanium. 27-46.(canceled)
 47. An intravascular stent, comprising: a first set ofcylindrical rings and a plurality of a second set of cylindrical rings,each set of cylindrical rings being radially expandable, longitudinallyaligned, and each with a first delivery diameter and a second implanteddiameter; a plurality of links connecting a plurality of adjacentcylindrical rings; wherein the stent includes a distal section, a centersection, and a proximal section; wherein the first set of rings areformed with first undulations having a first cross-sectional width andthe second set of rings are formed with non-overlapping undulationshaving a second, relatively smaller cross-sectional width, and thesecond set of rings having a higher concentration of undulations thanthe first section.
 48. The stent of claim 47, wherein the first set ofrings are located within the proximal section of the stent and thesecond set of rings are located within the center section of the stent.49. The stent of claim 48, further comprising a third set of cylindricalrings are located within the distal section of the stent, wherein thethird set of cylindrical rings are formed with undulations having thefirst cross-sectional width.
 50. The stent of claim 47, wherein thelinks comprise a first set with a first cross-sectional width and asecond set with a second, relatively smaller cross-sectional width thanthe width of the first set of links, and the first set of links connectthe first set of rings together and a plurality of the second set oflinks connect a plurality of the second set of rings together.
 51. Thestent of claim 47, wherein the first set of links are formed withW-shaped undulations, and the second set of links are straight.
 52. Thestent of claim 47, wherein the first set of rings are formed withV-shaped and U-shaped undulations and wherein the second set of ringsare formed with V-shaped and U-shaped undulations.
 53. A method fordelivering an intravascular stent in an artery having vulnerable plaque,comprising: providing an intravascular stent delivery assemblycomprising an elongated catheter for delivering the intravascular stenthaving a distal section, a proximal section, and a center section, eachsection having links and rings with undulations, wherein the undulationsof the center section are non-overlapping and wherein the center sectionhas a higher undulation concentration than the distal section andproximal section so that less stress is effected on the tissue of theartery by the center section than by the distal and proximal sections;advancing the stent delivery assembly into an atherosclerotic arterywithin the patient's body lumen; positioning the stent in a region ofthe artery containing vulnerable plaque; implanting the stent in theartery such that only the center section of the stent apposes andcontacts a region of the artery containing vulnerable plaque;withdrawing the stent delivery catheter assembly from the patient.